Print Friendly  |  
  • LinkedIn
  • Add to Favorites

 Provider Eyes PDPM Transition With Expectations for Smooth Rollover

The time is now for skilled nursing operators to execute their transition plans to a new payment system for Medicare reimbursement, with the rollover to the Patient-Driven Payment Model (PDPM) just a week away on Oct. 1. One major player in the profession, HCR ManorCare, tells Provider that expectations are high for a smooth implementation process, even if the exact changes to reimbursement will not be known immediately.

Martin Allen, vice president, reimbursement, HCR ManorCare, says the organization and its 175 skilled centers across 18 states have been working at the PDPM prep game for some time and are all set for the big day. To get ready, the provider utilized the outreach efforts by the American Health Care Association (AHCA) and its PDPM Academy educational program, which has helped ease the burden, he says.

Another help that came throughout the preparation process was what Allen called the “steady dialogue” between staff at the Centers for Medicare & Medicaid Services (CMS) and AHCA leadership and member providers.

“So, having been through the RUGs [resource utilization groups] implementation in the late 1990s and kind of comparing the tools available then and now, it is like night and day,” Allen says. “The approach AHCA has taken has been comprehensive times 10. If a provider has used it [the educational training] or paid attention to available resources to develop a framework for creating their own plan, they will be prepared.”

Inside HCR ManorCare, the training and preparation efforts have been widespread, but the most important employees in need of PDPM prep manage the Minimum Data Set (MDS) reporting process.

“The MDS staff, the folks that do clinical assessments, and therapy, they are the two largest teams we focused on,” he says. “In total, we have completed department-specific training for eight other areas, covering even small items with which they have to be familiar.”

Experts believe PDPM reimbursement changes will most impact therapy (Physical Therapy/Occupational Therapy and Speech) and non-therapy ancillary (NTA) factors, with Allen saying everyone in contact with a resident can have an effect on PDPM areas and the corresponding new coding in MDS.

Looking back now, right before the transition, at how CMS has rolled out the new payment model, Allen says there have been no real surprises in the materials the agency has released along the way for PDPM. But, he notes that PDPM was not the first iteration of a new proposed payment system for skilled nursing centers under the Medicare program.

There were struggles when the new payment system was still the RCS-1 (Resident Classification System) proposed model, he says. “There was a very strong dialogue about RCS-1, the predecessor proposal,” Allen says. “So, when PDPM was proposed CMS had taken all of the comments from RCS-1 and came out with very descriptive PDPM language.”

The key question now, besides how the rollover will go in a technical sense, is how reimbursement levels will be impacted by PDPM. Allen says HCR ManorCare and its analysis predict not much of a change.

“The documents we have looked at have consistently shown we expect to be in a very small band above or below where we are now. We have some issues, as do all providers, where some percentage of ICD-10 diagnostic groups don’t match what CMS will accept on a claim, but the real challenge using ICD-10s is estimating how those are going to be scored or grouped,” he says.

When the analysis of PDPM’s impact first started, 40 to 50 percent of provider claims had ICD-10s that showed as CMS “Return to Provider” codes, but through training now that number is much smaller. “We hope that overall PDPM will be a net positive, although it is designed by CMS to be budget-neutral,” Allen says.

The first indications of how PDPM will affect the bottom line will come from MDS, he says, since that data will be available as soon as it is submitted.

“There are tools available that show patient revenue and days to compare to pre-PDPM. If we can do this then CMS, as recipient of all the claims, will be able to analyze the impact instantly,” he says.

November might be premature for first results, Allen says, “but certainly we will know by the first quarter of 2020 when we can look at revenue changes vs. what we expected, and also if therapy delivery and other cost centers have been impacted."

Facebook.png   Twitter   Linked-In   ProviderTV   Subscribe

Sign In